Difficult airway management algorithms: a directed review

Abstract

The primary aim of this study was to identify, describe and compare the content of existing difficult airway management algorithms. Secondly, we aimed to describe the literature reporting the implementation of these algorithms. A directed search across three databases (MEDLINE, Embase and Scopus) was performed. All articles were screened for relevance to the research aims and according to pre-determined exclusion criteria. We identified 38 published airway management algorithms. Our results show that most facemask employ a four-step process as represented by a flow chart, with progression from tracheal intubation, facemask ventilation and supraglottic airway device use, to a rescue emergency surgical airway. The identified algorithms are overwhelmingly similar, yet many use differing terminology. The frequency of algorithm publication has increased recently, yet adherence and implementation outcome data remain limited. Our results highlight the lack of a single algorithm that is universally endorsed, recognised and applicable to all difficult airway management situations.

Consensus statement: Safe Airway Society principles of airway management and tracheal intubation specific to the COVID ‐19 adult patient group

“…In addition, there are generic resources already available to facilitate airway rescue and transition to the “can't intubate, can't oxygenate” (CICO) scenario . Many of these algorithms are similar in content and should be followed where they do not contradict the specific recommendations for patients with COVID‐19.…”

Difficult Airway Society guidelines for awake tracheal intubation (ATI) in adults

“…The reported incidence of requirement for emergency FONA and death due to airway management are 0.002–0.07% (1:50,000–1:1400) and 0.0006–0.04% (1:180,000–1:2800), respectively . The risk and severity of adverse outcomes during difficult airway management is highlighted by the plethora of guidelines and cognitive aids for airway rescue .…”

“…The reported incidence of requirement for emergency FONA and death due to airway management are 0.002-0.07% (1:50,000-1:1400) [1,27,28] and 0.0006-0.04% (1:180,000-1:2800), respectively [1,28]. The risk and severity of adverse outcomes during difficult airway management is highlighted by the plethora of guidelines and cognitive aids for airway rescue [29]. Awake tracheal intubation involves placing a tracheal tube in an awake, spontaneously-breathing patient, most commonly with flexible bronchoscopy (ATI:FB) or videolaryngoscopy (ATI:VL, Table 1).…”

The Anesthesiologist’s Role in Teaching Airway Management to Nonanesthesiologists

“…A recent review of difficult airway management guidelines found more than 35 different guidelines have been published in the past 20 years (Fig. 3) [104]. As noted by Chrimes and colleagues [1], ''[t]he multiplicity of airway algorithms is both a cause and effect of the professional silos clinicians currently occupy: having different algorithms for specific clinical contexts reinforces the erroneous notion that the issues encountered and/ or the strategies to address them are unique to each context, deterring collaboration.''…”